Individual
MR. FREDERICK LEON POLANDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A
Contact information
Practice address
580 BLACK RIVER RD, GEORGETOWN, SC 29440-3302
(843) 652-4000
(843) 652-4004
Mailing address
2234 COLONIAL BLVD, ATTN: PAYER CONTRACTING & RELATIONS DEPT., FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TL1940
SC
363AM0700X
Medical Physician Assistant
MA002186L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2175863
UNITED HEALTHCARE
WV
01
—
5627895
AETNA
SC
01
—
80026712
SELECT HEALTH
SC
01
—
8600568
AETNA
WV
01
—
P01225399
RAILROAD MCR
SC
Enumeration date
09/14/2006
Last updated
12/16/2014
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